At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to startCaring. Connecting. Growing together.You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:Evaluate prescriptions and patient historiesInterpret physicians' prescriptions and clinical documentation, accesses clinical criteria and compendia supportConsult with customers, patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requestsConduct Quality Assurance and verify the accuracy of all prescriptions to render appeal decisionProvide explanations and interpretations within area of expertiseReview formulary and utilization management guidelines to determine if the drug should be a covered benefit for the beneficiary based on their medical historyResearch, evaluate, and make determinations on member and provider appeals of pharmacy coverage decisionsGather complex clinical information, consider approved compendia, medical literature, coverage policy, and criteria information and work within regulatory guidelines to render decisions. Decision may require consulting with Plan Medical Directors and the beneficiaries treating physicianAnswer questions from support personnel regarding prescription drugsPosition requires excellent record keeping skills, thorough documentation, clear and concise written/verbal communications skills
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to startCaring. Connecting. Growing together.You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
Want more jobs like this?Getjobsdelivered to your inbox every week.
Want more jobs like this?
Getjobsdelivered to your inbox every week.
Select a locationGet Jobs
Select a location
